Provider Demographics
NPI:1063221935
Name:BLOOM, CANDACE RORI
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:RORI
Last Name:BLOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HIGHLAND AVE NE UNIT 601
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1381
Mailing Address - Country:US
Mailing Address - Phone:706-464-7380
Mailing Address - Fax:
Practice Address - Street 1:375 HIGHLAND AVE NE UNIT 601
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1381
Practice Address - Country:US
Practice Address - Phone:706-464-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290420163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine